How to Navigate the Residency Selection Process

How to Navigate the Residency Selection Process

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  How to Navigatethe Residency Selection Process Francis S. Nuthalapaty, MD Upstate Chapter Christian Medical and Dental Association
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  What do youthink would make the “optimal” residency training environment?
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  The Optimal GME Environment EducationService
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  Defining the OptimalResidency Author, Year Population Scope N (Response Rate) DiTomasso, 1983 PGY-1 FP National 830 (46%) Weissman, 1984 PGY-1 Psychiatry National 274 (51%) Sledge, 1987 Graduates entering Psych. National 318 (64%) Hitchcock, 1989 PGY-1 FP 1 State 115 (91%) Simmonds, 1990 Graduates 1 Univ. 111 (71%) DeLisa, 1992 Graduates 1 Univ. 73 (41%) Flynn, 1993 Graduates 1 Residency 315 (88%) Lebovits, 1993 Graduates 1 Univ. 197 (87%) Mayeaux, 1993 PGY-1 FP National 660 (27%) Diebold, 1995 PGY-1 EM National 463 (68%)
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  The Optimal Residencyin the 80’s – 90’s 1.Geographic location 2.Quality of training experiences / educational curriculum 3.Academic reputation of program 4.Perception of house staff satisfaction
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  The Changing GMELandscape The GME training environment has changed dramatically over the past 4 decades –Resident unionization –Duty Hour Restrictions (2002) –Federal definition of resident employment status (2005)
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  Controllable Lifestyle andSpecialty Choice – The Educator’s Viewpoint • Coined by Schwartz in 1989 • Broadly defined as control over the number of hours devoted to professional responsibilities to enable time for leisure, family, and avocational pursuits • Shown to be a significant determinant of specialty choice
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  The Contemporary GME Environment GME ServiceEducation ResidentWell-being
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  What’s important to residencyapplicants in the new millennium?
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  The Optimal Residencyin the new Millennium Factor No. % 1. Resident satisfaction with program 7,043 98.1 2. Level of concern program has for its trainees 7,037 98.0 3. Perception of “fit” into residency 6,948 96.7 4. Geographic location 6,836 95.2 5. How well residents work together 6,753 94.0 6. Quality of hospital facility 6,176 86.0
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  The Optimal Residencyin the new Millennium Factor No. % 7. Amount of faculty supervision 5,604 78.0 8. Academic reputation 5,474 76.2 9. Level of resident autonomy 6,836 76.0 10.Amount of faculty teaching 6,753 74.1 11.Amount of conferences 5,294 73.7 12.Size of patient case load 4,230 58.9
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  The Optimal Residencyin the new Millennium Factor No. % 13.On-call frequency 4,018 55.9 14.Cost of living in program area 3,656 50.9 15.Amount of clinical support services 3,608 50.2 16.Emphasis on research 3,067 42.7 17. Emphasis on teaching students 2,632 36.6 18.Employee benefits 2,462 34.3 19.Salary 1,600 22.3 20.Supplemental income opportunities 1,408 19.6
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  Factors in InterviewSelection
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  2013 NRMP ApplicantSurvey
 Important Factors In Interview Selection Factor 2015 2013 2011 2009 1. Geographic location 87% 95% 95% 95% 2. Academic reputation of the program 83% 90% 92% 92% 3. Perceived goodness of fit 80% N/A N/A N/A 4. Quality of residents in program 70% 79% 88% 88% 5. Quality of educational curriculum 68% 86% 92% 92% 6. Academic Setting 68% 74% 87% 87% 7. Work / Life balance 64% 68% 87% 87%
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  The Learning Culture Academicrigor vs. Malignancy Autonomy vs. Supervision Role models vs. Mentors
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  What’s important to theProgram?
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  Factors in SelectingApplicants
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  2014 NRMP ProgramDirector Survey Factors in Selecting Applicants for Interviews Factor 2014 2012 2010 2008 Step 1 Score 94% 82% 73% 82% Letters of Recommendation 86% 81% 71% 75% MSPE (Dean’s Letter) 84% 68% 60% 76% Step 2 CK Score 80% 70% 61% 70% Personal Statement 78% 77% 68% 75% Grades in Clerkships 70% 71% 62% 71%
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  Breakdown of USMLEStep 1
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  USMLE: Making theCut The boxes in the boxplots above represent the interquartile range (or IQR, which is the range between the 25th and 75th percentiles) and the line in the box is the median. The x-shaped symbol in the box is the mean Obstetrics and Gynecology
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  A Structured Approachto Residency Application 1. Set a Timeline 2. Gather Data about your Specialty 3. The Letter of Recommendation 4. The Personal Statement 5. Electives – Good or Bad? 6. The Interview 7. The Rank List
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  The Match Timeline 1.Late May: ERAS user guide available 2. June: MyERAS website open for use 3. Sept 15: Programs begin download 4. Oct 1: MSPE sent to Programs 5. Jan 14: Rank list entry begins 6. Feb 23: Students finalize Rank list 7. Mar 13: SOAP begins 8. Mar 17: Match Day!
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  Setting a Timeline 1.Review the Match Timeline 2. Review steps in Application Process 3. Set deadlines for each step
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  Gathering Data 1. NRMPReports –Match Outcomes –Program Director Survey –Applicant Survey
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  Comparing the Specialties
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  Comparing the Specialties
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  Step 1 andOBGYN Match
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  Comparing the Specialties
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  Step 2 andOBGYN Match
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  The Application Process 1.Extramural Electives 2. ERAS Application 3. Personal Statement 4. Letters of Recommendation 5. Interviews 6. Rank Order List 7. Program Follow-up
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  The Application Process Shouldyou do an Extramural Elective?
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  1. Electives –Good or Bad? – Electives are extended interviews – Most beneficial for very strong candidates and weak/marginal candidates – Could help or potentially hurt intermediate candidates – Expensive! The Application Process
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  The Application Process 2.ERAS Application – 4 main components – Identifiers – Education – Current / Prior Training – Experiences
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  The Application Process Whatmakes a good Personal Statement?
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  The Application Process 3.Personal Statement – Before you start – Check with program for any special content requirements – Line up at least 3 reviewers: • Medical perspective • Lay perspective • Editorial perspective – Be prepared to write MANY drafts
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  The Application Process 3.Personal Statement – What to include – Your motivations for a career in medicine – How you chose the specialty and why you are a good “fit” – Distinguishing features of your personal / professional background – Your unique qualities /talents / passions relevant to the specialty – What you see yourself doing after training – your future scope of practice
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  The Application Process 3.Personal Statement – What to avoid – Autobiography – Why you like the specific program – Poor composition • Grammar • Spelling • Literary style
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  The Application Process What’sthe best strategy for Letters of Recommendation?
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  4. Letters ofRecommendation (Advice for Students) – Check individual program requirements – Ask early / ask often – Always ask the faculty person what the strength of his/her recommendation will be! The Application Process
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  4. Letters ofRecommendation (Advice for Faculty) – Ask the student to give you as much data as possible • Transcript, USMLE Scores • Personal Statement • CV – Meet with the student / ask questions – Always discuss the strength of your recommendation – Proof read to ensure student’s name is correct throughout The Application Process
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  The Application Process Whatshould be your approach to scheduling interviews?
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  The Interview Roulette- 2008
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  The Interview Roulette- 2012
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  5. Interviews – Schedulethem early – Many programs complete all interviews by the end of December – “Be nice” to all contacts – Be prepared for behavioral interviews The Application Process
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  The Rise ofBehavioral Interviewing
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  How should you determineyour rank list order? The Application Process
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  The Application Process 6.Rank Order List – Rank based on where you want to be – not where you think you were liked – More programs = greater match success – Many programs will try to pin you down – don’t be afraid to tell programs you liked them – but don’t divulge your ranking.
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  Applicant Rank List
 SingleMost Important Factor Factor % Potential “fit” into residency program 34.6 Geographic location 30.3
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  2015 NRMP ApplicantSurvey
 Important Factors In Ranking Factor % 1. Overall goodness of fit 87 2. Interview day experience 81 3. Geographic location 80 4. Quality of residents in program 74 5. Reputation of program 71 6. Quality of faculty 66 7. Housestaff morale 63
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  2015 NRMP ApplicantSurvey
 Ranking Strategies Factor 2015 2013 2011 1. I ranked in the order of my preferences 92% 98% 99% 2. I ranked all programs I was willing to attend 76% 71% 95% 3. I ranked all programs at which I interviewed 69% 60% 63% 4. I ranked a mix of competitive and less competitive programs 64% 53% 88% 5. I ranked 1 or more less competitive programs as a safety net 57% 34% NA
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  How do Programs determinetheir rank list order? The Application Process
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  Program Rank Factors
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  Program Rank Factors 1.The “Big 3”: –Residency Interview - Interactions with faculty - Interactions with residents –Interpersonal Skills –Academic performance
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  How many programs shouldyou rank? The Application Process
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  Rank List Length
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  Rank List Length
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  The Application Process 6.Rank Order List – Rank based on where you want to be – not where you think you were liked – More programs = greater match success
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  The Application Process 7.Program Follow-up – Recognize that each program has differing expectations – The program’s view of applicant follow-up is based on many factors • PD experience • Program competitiveness
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  Quotes from PDs “Ifthey email you and tell you that they loved the program and it is their first choice it has no significance. After doing this for the last 13 years, I don't believe any of the emails or even the recommendations from medical school. They played no part in the decision making process since I don't think they have any value in predicting who will fit in your program.” “In my time as a Program Director, we ranked students that expressed great desire in our program near the top. But ONLY if we felt that he or she has the necessary criteria that we set. These criteria included grades, references, research interest and how they performed in the interviews.”
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  Quotes from PDs “Iencourage applicants to email me rather than send letters, although they all took me up on my offer this year, and responding is a lot of effort.    It helps me a lot to know that    an applicant is genuinely interested in our program, so I do think they should reach out to those programs at the top of their list. Telling me I'm "in the top" is somewhat helpful, but may not mean much.    Telling me I'm "#1" on the list tells me more, but isn't necessary, and they may change their mind. It's hard to keep someone high on the list if none of us have heard a word out of them since they interviewed.  We assume, sometimes incorrectly, that they're not interested in us.”
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  Useful Resources 1. AAMCResources: –ERAS Information Website –Roadmap to Residency Document –Careers in Medicine Website 2. NRMP Resources: –Charting Outcomes in the Match –2012 Program Director’s Survey –2011 Applicant Survey
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  Useful Resources 1. ProgramInformation: –FREIDA –ACGME 2. Other Resources –Career and Professional Development Website –UK Career and Professional Development Website
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  Useful Resources